7-Payment Assistance (SBE Set-Aside).pdf.pdf

PDF 61 KB Posted

Attached to
Pipeline Work Order Construction Services - WORCs 6
Solicitation number
IFB-26-00426
Issued by
Hillsborough County, Florida

About this file

This is a Payment Assistance Request Form for the Hillsborough County, Florida Small Disadvantaged Business Enterprise (SDBE) Program, used by SDBE-certified prime contractors bidding on county projects. The form permits joint check requests involving a supply or material house and the prime contractor for specific projects. The form requires the contractor to identify the project name, the supply house or vendor receiving joint payment, and specify the primary supplies to be purchased. The contractor must certify that payment assistance, if granted, will be utilized solely for the stated county project and identified supply house.

This Payment Assistance form is directly associated with the Pipeline Work Order Construction Services - WORCs 6 project, a Hillsborough County Capital Projects Department construction contract estimated at $12,075,000.00 for water mains, reclaimed water mains, wastewater force mains, and related installations at various water, reclaimed water, and wastewater facilities. The solicitation includes an SBE subcontractor participation goal of 6%, and this form provides an additional mechanism to support SDBE prime contractors through joint payment arrangements with material suppliers, thereby facilitating working capital and cash flow management for certified small disadvantaged businesses undertaking this substantial infrastructure project.

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Text version

PA – 1

1240 PMTASST.doc

(REV. 07/19/05)

THIS REQUEST MUST BE SUBMITTED WITH THE BID

(If Payment Assistance is Being Requested)

HILLSBOROUGH COUNTY, FLORIDA

SMALL DISADVANTAGED BUSINESS ENTERPRISE (SDBE) PROGRAM

REQUEST TO USE PAYMENT ASSISTANCE

This form shall be used by a Hillsborough County certified Small Disadvantaged Business Enterprise (SDBE) bidding as a prime contractor on a project. Pursuant to the Payment Assistance provisions of the SDBE Program, joint checks may be requested for a supply or material house and the prime contractor.

The desires to utilize the (Name of Contractor) assistance provision on (Project Name) if awarded the contract. The joint check(s)shall be issued in the name of and (Name of Contractor)

(Supply House/Address)

The primary supplies to be purchased are/is (Specify)

. The certifies that if this (Contractor) request is granted, it will be utilized only for the County project and supply house stated above.

Signature of Authorized Contractor Representative

Title

Date

File details come from the government source that posted it. Updated .